Hypovolemic shock treatment

Prepare a treatment plan with clearly defined outcome criteria for a hypovolemic shock patient that includes both fluid management and other pharmacologic therapy. 

Compare and contrast the relative advantages and disadvantages of crystalloids, colloids, and blood products in the treatment of hypovolemic shock. 

Major treatment goals in hypovolemic shock following fluid resuscitation are as follows arterial systolic blood pressure greater than 90 mm Hg within 1 hour, organ dysfunction reversal, and normalization of laboratory measurements as rapidly as possible (less than 24 hours). 

Successful treatment of hypovolemic shock is measured by the restoration of blood pressure to baseline values and reversal of associated organ dysfunction. The likelihood of a successful fluid resuscitation will be directly related to the expediency of treatment. Therapy goals include ... 

Inotropic agents and vasopressors are generally not indicated in the initial treatment of hypovolemic shock (assuming that fluid therapy is adequate),... 

Conover CD, Linberg R, Lejeune L, et al. PEG-Hemoglobin as a resuscitation solution in the treatment of hypovolemic shock in the anesthetized rat. Artif Organs 1999 23 1088. 

Postoperative hepatic dysfunction is typically associated with factors such as blood transfusions, hypovolemic shock, and other surgical stresses rather than volatile anesthetic toxicity. However, a small subset of individuals who have been previously exposed to halothane may develop potentially life-threatening hepatitis. The incidence of severe hepatotoxicity following exposure to halothane is in the range of one in 20,000-35,000. Obese patients who have had more than one exposure to halothane during a short time interval may be the most susceptible. There is no specific treatment for halothane hepatitis, and therefore liver transplantation may ultimately be required in the most severe cases. 

Life-threatening splenic mpture occnrred in a 22-year-old woman with acnte myeloid lenkemia (53). The rupture was diagnosed in the presence of abdominal pain and signs of hypovolemic shock, 10 days after she started G-CSF treatment to support peripheral blood stem cell transplantation. Histology after splenectomy showed only small clnsters of myeloblasts and no specific cause for the mpture. In particnlar, she was still pancytopenic at the time of splenic mpture. 

Humanserumalbumin 582 amino acids with 17 disulphide bridges Albutein (Alpha Therapeutic Corporation) Yeast Treatment of hypovolemic shock Adjunct in haemodialysis... 

Although the basic pathophysiology is similar for the various causes of hypovolemic shock, there are unique considerations relative to each. For example, whereas isolated head injuries associated with trauma typically do not result in substantial blood loss or shock, pelvic fractures may sequester several liters of blood as hematoma formation. Patients with traumatic or thermal injuries, as well as postoperative patients, may have substantial fluid accumulation in sites where it cannot be readily transferred back into blood vessels (i.e., third-spaced fluid) for maintaining pressure. With these types of injuries, prompt control of compressible bleeding sources with rapid patient transfer to the hospital for definitive treatment may preclude the cascade of events leading to shock. Indeed, with trauma patients, a scoop and run approach is used in most urban hospitals that places a priority on rapid transport to a hospital. ... 

Figure 24-4 is an algorithm that summarizes many of the treatment principles discussed in this chapter. The algorithm is an example of one approach to the adult patient presenting with hypovolemic shock. It presumes that initial rehydration attempts (i.e., outpatient or prehospital) were unsuccessful in restoring circulation. Obviously, modifications may be needed for patient-specific forms of hypovolemic shock. Other limitations of the algorithm should be recognized, particularly the decisions to add or to substitute colloid or... 

In a questionnaire survey 66 surgeons who had used tumescent anesthesia for liposuction reported that the complications in 15336 patients had been infrequent and minor [42 ]. There had been no serious complications such as death, embolism, hypovolemic shock, perforation of peritoneum or thorax, or thrombophlebitis. Blood transfusions had not been required and there had been no admissions to the hospital for treatment of complications. 

Extensive burn injuries produce a systemic response that pulls fluid from the vascular system into the interstitial space. This is exacerbated in burns greater than 20% TBSA by a significant capillary leak into the microvasculature and generalized edema. Without proper treatment, intravascular fluid loss and hypovolemic burn shock result. This is why immediate initiation of fluid resuscitation is important. A successful fluid resuscitation will maintain intravascular volume and organ perfusion until capillary membrane integrity is restored (approximately 24 to 48 hours postinjury). 

Isoproterenol (aerosol delivers 131 mcg/dose in hne mist) is indicated in the treatment of bronchospasm associated with acute and bronchial asthma, pnlmonary emphysema, bronchitis, and bronchiectasis. Parenteral isoproterenol is indicated as an adjnnct to flnid and electrolyte replacement therapy in the treatment of hypovolemic and septic shock, low cardiac ontpnt states, CHF, and cardiogenic shock. Sublingual or rectal isoproterenol is... 

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